Stimulant Drug Class

Stimulants are also significant drugs of abuse, and some of the most notorious illicit drugs are in this category. Long-term abuse of stimulants can have significant consequences, including long-term health risks.

The following are some of the most popular stimulant substances:

  • Caffeine
  • Nicotine
  • Cocaine
  • Methamphetamine
  • Ecstasy (MDMA)
  • Prescription and over-the-counter stimulants

Caffeine Products

While it is normally not considered to be dangerous, consuming too much caffeine can lead to significant issues with insomnia and anxiety. It can trigger other long-term health effects, such as an increased risk for cardiovascular disease.

Caffeine can produce physical dependence (withdrawal symptoms). Withdrawal from caffeine can be distressing. It can include lethargy and fatigue, irritability, and headaches.

Nicotine Products

The three most commonly used psychoactive drugs in the world are caffeine (coffee), nicotine (tobacco products), and alcohol.

There are actually few medicinal uses for nicotine, but the Centers for Disease Control and Prevention (CDC) consistently reports that slightly under 15 percent of U.S. adults over the age of 18 smoke cigarettes. The National Institute on Drug Abuse (NIDA) reports that the leading preventable cause of death in the United States is the use of tobacco (cigarette smoking).

Nicotine has similar effects to caffeine, including increased alertness and amplified feelings of energy.


One of the most well-known stimulants in the world, cocaine is derived from the South American coca plant.

Although you may think of cocaine as an illicit drug, it is actually still used sparingly for medicinal reasons. It is a C II (Schedule II) controlled substance, meaning that it can be used for medical purposes in specific circumstances. However, its medical uses are limited, and it is not typically prescribed for individual use.

Cocaine abuse occurs as a result of several different modes of administration, including grinding it up into a powder and snorting it, smoking it (crack cocaine), and mixing it with water and injecting it. It can also be taken orally, but this is the most infrequent method of administration.

Crack cocaine is created by heating up powdered cocaine and crystallizing it, making it particularly suitable for smoking.

Cocaine Effects

Despite the form of cocaine that is abused, the effects are the same.

  • Euphoria
  • A rush of energy
  • Excitability and feelings of invincibility
  • Dilated pupils
  • Decreased appetite
  • Less need for sleep
  • Psychosis (hallucinations and/or delusions)

People who snort cocaine may have runny or bloody noses. People who smoke crack may develop respiratory issues.

The effects of cocaine are typically short-lived. When cocaine is snorted or smoked, the effects last for even less time.

Cocaine users typically binge on the drug. The effects of the drug rapidly dissipate, and feelings of apathy and depression begin to take over. This leads to individuals constantly bingeing on the drug to avoid the crash associated with stopping use.

As with most stimulants, tolerance to cocaine develops quickly. If you begin using cocaine on a regular basis, you will need to increase the amount you use significantly, within a very short period of time, to get the same effects that you first achieved.

Eventually, the euphoria associated with cocaine use (and other stimulants like methamphetamine) becomes less intense. To avoid the negative effects of the crash and withdrawal — such as lethargy, irritability, apathy, and depression — you will need to continue abusing cocaine.

Abuse Rates

Rates of cocaine abuse peaked in the 1980s and 1990s, and then declined due to the popularity of other less expensive drugs. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports the following:

  • In 2016, about 38.9 million people reported at least one lifetime use of cocaine.
  • In 2016, about 8.8 million reported some lifetime use of crack cocaine.
  • In 2017, about 40.6 million people reported some lifetime use of cocaine.
  • In 2017, about 9.6 million people reported some lifetime use of crack cocaine.


Like cocaine, methamphetamine (meth or crystal meth) is commonly depicted as an illicit drug of abuse. However, it is a controlled substance in the C II classification. Medicinal methamphetamine (brand name: Desoxyn) may be prescribed to treat ADHD in cases that do not respond to other stimulants.

Despite this, methamphetamine is more commonly viewed as a substance of abuse. The substance is most often manufactured in private laboratories.

Street methamphetamine or crystal meth is produced by extracting stimulant medications from over-the-counter drugs, like cold medicines or diet aids, and combining them with other substances. Many of these other substances are potentially toxic. The combination produces a powder or crystal form of methamphetamine.

Crystal meth is commonly smoked or injected. The adulterants used in manufacturing the drug can produce accelerated damage to numerous organ systems, including the teeth (“meth mouth” or rotting teeth), skin, heart, liver, lungs, and brain.

Crystal Meth Effects

The effects of crystal meth are similar to the effects of other stimulants like cocaine, although in some cases, the euphoria and feelings of invulnerability may be even more extreme.

Aside from the toxic effects, medical issues can arise from methamphetamine abuse.

  • An extremely elevated body temperature that can lead to dehydration and/or brain damage
  • Seizures
  • An increased potential to develop psychosis
  • Severe itching
  • Long-term cognitive issues as a result of alterations and damage to the brain

Since meth is commonly smoked or injected, the potential to binge on it is increased. The potential to develop psychosis and seizures is also increased. When you are bingeing on a drug, overdose is more likely, and an overdose on meth can be fatal.

Abuse Rates

Crystal meth abuse is probably one of the reasons for the stagnation of cocaine abuse in the U.S. Meth is less expensive and easier to obtain than cocaine.

Abuse of meth has declined somewhat in recent years due to the popularity of prescription painkiller abuse. According to SAMHSA:

  • In 2016, about 14.5 million people admitted to some lifetime use of methamphetamine.
  • In 2017, about 14.7 million people admitted to some lifetime use of methamphetamine.


Ecstasy, also known as Molly, is the street name for the drug 3, 4-methylenedioxy-methamphetamine (MDMA). The drug has both stimulant and hallucinogenic effects, and it was a common “club drug” at one time. In addition to producing stimulation and hallucinations, it can also increase a sociability.

The drug affects many different neurotransmitters. Long-term use is associated with significant alterations in the brain.

MDMA is being investigated for its potential to treat post-traumatic stress disorder (PTSD). Currently, it is an illicit drug in the C I class of controlled substances (Schedule I). This means it is illegal to possess it except with special permission from the government (such as for research).

Ecstasy sold on the street today is most likely significantly adulterated with other substances, including methamphetamine and other drugs. According to SAMHSA:

  • In 2016, about 18.5 million people reported some lifetime use of ecstasy.
  • In 2017, about 19.2 million people reported some lifetime use of ecstasy.

Other Prescriptions

Other prescription stimulants are potential drugs of abuse, most notably drugs used to treat ADHD and diet aids like Dexedrine.

Prescription stimulants work the same way as the other stimulants mentioned above — by increasing the amounts of neurotransmitters in the brain like dopamine and norepinephrine. The drugs can lead to increased focus, improved energy, decreased appetite, and a lowered need for sleep.

Drugs that contain the stimulant methylphenidate (Ritalin and Concerta) and medications that contain amphetamines (Adderall and Dexedrine) are included in this category.

These drugs are not often abused by people who have legitimate prescriptions for them. People who abuse them generally get them from those with legitimate prescriptions, or they buy them on the street. When abused, the pills are typically crushed and the powder is snorted, or it can be mixed with water and injected.

These prescription medications can produce similar effects to cocaine and methamphetamine when abused. Such abuse also carries similar adverse consequences.

Abuse Rates

Prescription stimulant abuse is popular among college students, often as they are attempting to cram for exams and write research papers. People who are in high-pressure jobs may also abuse these drugs to improve focus and work longer.

However, the abuse of prescription stimulants is not associated with increased academic achievement or job performance. Over the long run, this abuse is more likely to result in decreases in these domains.

According to SAMHSA:

  • In 2016, about 5.6 million people reported misusing prescription stimulant medications.
  • In 2017, about 5.8 million people reported misusing a prescription stimulant medication.


Abuse of anabolic steroids, synthetic forms of testosterone, most often occurs in athletes and individuals interested in physical fitness or bodybuilding. While these drugs have stimulant properties, they are not common drugs of abuse except for this subset of individuals, but they can be addictive.

Long-term abuse of steroids can lead to significant medical issues, including an increased risk to develop cancer, the development of male secondary sexual characteristics in females, the development of female secondary sexual characteristics in males, and issues with aggression and emotional functioning that can include outbursts of anger and problems with emotional control.

Treatment for Stimulant Use Disorders

Continued abuse of any stimulant can lead to the development of a stimulant use disorder, the current term to describe abuse or addiction to stimulants.

Although withdrawal from stimulant medications is not considered to be potentially fatal, people withdrawing from them can experience significant emotional distress and issues with physical functioning that require them to be under the supervision of a physician.

Treatment for stimulant use disorders should include the following components:

  • A thorough assessment of physical, cognitive, emotional, and social functioning to develop a treatment plan
  • Placement in a physician-assisted medical detox program to assist with withdrawal
  • Medications to address withdrawal symptoms and other issues
  • Behavioral interventions, such as therapy and group participation (12-step groups), to address issues with coping and avoid relapse
  • Care for any co-occurring mental health issues
  • A long-term aftercare program to prevent relapse
  • Significant support from family and friends

Consider your treatment to be a long-term, even lifelong, process that focuses on abstinence.

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